cresterea si dezvoltarea somatica
DESCRIPTION
CRESTEREA SI DEZVOLTAREA SOMATICA. Dr. Ruxandra Vidlescu. Proces dinamic, inceput in momentul conceptiei produsului uman si continuat pana la maturitate - modificari morfofunctionale si psihointelectuale CRESTEREA modificari de marime ale organismului - PowerPoint PPT PresentationTRANSCRIPT
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Dr. Ruxandra Vidlescu
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Proces dinamic, inceput in momentul conceptiei produsului uman si continuat pana la maturitate
-modificari morfofunctionale si psihointelectuale
CRESTEREA modificari de marime ale organismului
DEZVOLTAREA procese care duc la diferentierea formelor, la modificarea structurala si functionala a aparatelor
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MULTIPLICARE CELULARA / HIPERPLAZIE
- mitoza (celulele somatice)- meioza (celulele sexuale)
! Functie de capacitatea de diviziune sunt tesuturi cu capacitate mare (maduva hematogena, epiderm, muc. digestiva), care pierd capacitatea de diviziune (tes. nervos, miocard) sau cu capacitate redusa (tes hepatic)
HIPERTROFIE CELULARA crestere de volum celular
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DIFERENTIERE CELULARA/ aparitia de celule cu functii specifice
Evolutia spre celule specializate are loc sub actiunea unor factori inductori
Dpdv genetic : represarea unui nr. variabil de gene Dpdv biochimic : acumularea unor substante
specifice
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LEGEA ALTERNANTEI segmentele corpului nu cresc toate in acelasi timp, ci alternativ
LEGEA PROPORTIILOR fiecare perioada a copilariei are ritmul ei propriu de crestere
LEGEA ANTAGONISMULUI MORFOLOGIC SI PONDERAL in perioadele de crestere acumulativa, diferentierea este redusa
LEGEA CRESTERII INEGALE fiecare segment al corpului are propriul sau ritm de crestere
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FACTORI GENETICI FACTORI NUTRITIONALI FACTORI DE MEDIU FACTORI EMOTIONALI FACTORI HORMONALI
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Influenteaza hotarator talia si greutatea finala a individului
TALIE baieti (formula predictiva)(0,545 x T 2ani) +(0,544 x T medie parinti) +37,1cm
TALIE fete (0,545 x T 2ani) +(0,544 x T medie parinti) +25,2cm
Formula WEECHFormula WEECH
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Actioneaza din timpul vietii intrauterine
Carentele nutritionale (globale sau selective) din timpul sarcinii greutate si talie mai mici la nastere
Carentele nutritionale (globale sau selective) din timpul vietii retard de dezvoltare ponderala staturala
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Factori geografici Zone temperate crestere armonioasa Zone inalte / temperaturi scazute talie si greutate
mai mici
Factori de microclimat
- conditii corespunzatoare : iluminat, incalzit, lipsa de poluare fonica sau de alte noxe, climat familial intelegator crestere armonioasa
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Strans corelati cu factorii socioeconomici
Reflecta – pozitia copilului in familie - relatia cu ceilalti membri ai familiei
- relatia cu comunitatea - stresul familial, afectivitatea si suportul familiei
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cu actiune antenatala hh fetali STH (secretat din S8)
hh materni care traverseaza bariera placentara (STH, gluco/mineralocorticoizi)
hh placentari (gonadostimuline, prolactina)
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STH intervine ca reglator al cresteriiactioneaza direct sau prin intermediul somatomedinelor
Actiuni : favorizeaza proliferarea condrocitelor in cartilaje, participa la sinteza proteinelor, stimularea catabolismului lipidic, favorizeaza retentia de azot, apa, sodiu, creste reabsorbtia tubulara a fosforului, favorizeaza calciuria
hh. tiroidieni intervin in osteogeneza (favorizeaza hipertrofia condrocitelor din cartilajele de crestere, mineralizarea osoasa, osteoliza si resorbtia osteoclastelor), stimuleaza sinteza si multiplicarea celulara, procesele oxidative celulare…
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hh suprarenalieni glucocorticoizi actiune inhibitorie pentru crestere; mineralocorticoizii stimuleaza sinteza ARNm si
ADN hh pancreatici
- insulina hormon anabolizant- glucagon hormon catabolizant
hh paratiroidieni (PTH) hh sexuali – hormonii androgeni anabolizanti pe
muschi, oase, maduva osoasa, stimuleaza cresterea si maturarea sexuala, opresc cresterea staturala la pubertate
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GREUTATE TALIE PERIMETRU CRANIAN
Alti indici : circumferinta bratului, grosimea pliurilor cutanate, BMI
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Curba gaussiana cu forma de clopot
- varful clopotului valoarea medie a varstei; -ramura ascendenta – variatii in minus-ramura descendenta – variatii in plus
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METODA DEVIATIEI STANDARD (DS)-DS = gradul de dispersie a valorilor observate in jurul valorii medii- distributia ideala 1DS (68% valori)- intre 2DS 95%- intre 3DS 99,7%
VALORI NORMALE intre 2 DS
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METODA PERCENTILELOR-percentila = pozitia unui membru al populatiei studiate fata de ceilalti membri
VALORI NORMALE intre p3 si p97
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VIATA INTRAUTERINA intre momentul fecundarii ovulului si momentul nasterii; dureaza 38-42 saptamani (260-293 zile)
2 etape – embrionara 0-8 (12) saptamani- fetala 8(12) – 42 saptamani
!curbe de crestere intrauterina LUBCHENCO
Supravegherea prin echografii succesive in timpul sarcinii
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CRESTERE PONDERALA lenta pana in S23, ulterior accelerata
- la 6L 25% GN
CRESTERE STATURALA varful cresterii in S21,apoi scade ritmul
- la 6L 70% TN
MATURATIE OSOASA - nounascutii > 3000g au nucleii epifizelor
femurale
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Factori nonendocrini
-sexul, GN a celorlalti frati, rangul copilului, malnutritia materna, fumatul, consumul de alcool, toxemia gravidica
Factori hormonali- STH, somatomedinele (IGF1, IGF2), hormonii
tiroidieni, insulina Factori genetici
- talia parintilor influenteaza talia FINALA a copilului
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GN - normala 2850 – 4500g (3000 – 3200g)
- mica <2500g - foarte mica <1500g - extrem de mica <1000g
!!!eutrofic/ mic/mare pentru VG
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Ritmul cresterii ponderale-an 1: L1-4 750g/L, L5-8 500g/L, L9-12 250g/L
4L=2GN, 1an=3GN- an2: 2500-3000g/an- an3: 2000g/an
- varsta scolara 3-5kg/an; perioada prepubertara mai accelerata
!!! >1an G=2V+9
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nastere :48-52 cm
Primul an : 24-30cm/an
- L1 4-5cm/luna,
- L2-3 4cm/luna, - L4 2cm/luna, - L5-12 1cm/luna
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Perioada anteprescolara 10-12cm/an
- 2ani 85cm, 3ani 95cm Perioada prescolara 6-8cm/an Perioada scolara 6cm/an ; accelerata la
pubertate
!!! >2ani T= 5V+80
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PERIMETRUL CRANIAN Nastere 35cm Ritm de crestere – 2cm/luna in trimestrul 1
- 3cm/trimestru pana la 1an
- La 1 an 45-46cm- La 3 ani 48cm- La 5 ani 50cm- La 15 ani 55cm
PC = T/2 + 10
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CRESTERE NORMALA : evolutie conform curbelor de referinta; se urmeaza culoarul in limitele 2DS
CRESTERE PATOLOGICA (accelerata, intarziata) : intersectarea culoarului normal
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Definitie : incetarea cresterii in greutate / pierdere in greutate
mai frecvent <2 ani
G < p5 (la mai multa masuratori) sau G < 80% G normala a varstei
cauze organice si nonorganice
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CAUZE ORGANICE LIPSA DE APORT subalimentatie, anomalii
congenitale (palatoschizis, sdr. Pierre Robin), dispnee (cardiaca/pulmonara care impiedica alimentarea), leziuni neurologice (encefalopatii, encefalite)
CRESTEREA PIERDERILOR varsaturi / diaree cronica, afectiuni renale
UTILIZARE NEADECVATA LA NIVEL TISULAR infectii cronice, boli metabolice/ endocrine
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CLINIC : suprimarea cresterii ponderale asteptate
afectarea taliei /PC In timp urmata de retard in dezvoltarea
mentala, apatie, tulburari de apetit, spasticitate neuromusculara / hipotonie
DIAGNOSTIC anamneza (alimentatie, varsaturi, diaree), examen clinic (talie, PC, tesut adipos, curbe de
referinta, eventuale manifestari patologice)
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CAUZE NONORGANICE FACTORI SOCIOECONOMICI
- familii cu venituri mici/dezorganizate, sarcina nedorita
- alimentatie necorespunzatoare, imunizari incomplete, infectii repetate
FACTORI DE MEDIU / PSIHOSOCIALI- Indiferenta familiala / copii institutionalizati- Copii traumatizati (abuzuri, stres)
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CAUZE NONORGANICE
DIAGNOSTIC anamneza atenta, examen clinic, urmarirea copilului in conditiile suprimarii factorilor cauzali
TRATAMENT dificil Presupune ajutor social, asistenta medicala in teren
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G, T, PC < p5 boala organica sistemica, neurologica
G < p5 boala digestiva
G, T < p5 boala endocrina / probleme nutritionale
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MASURI PROFILACTICE eliminarea factorilor care duc la esecul cresterii
Prevenirea factorilor nonorganici (de mediu, familiali)
Diagnostic precoce si tratament al afectiunilor organice
Imunizari regulate
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DEFINITIE talie <-2DS
pentru varsta si sex
Nanism talie < -4DS pentru
varsta si sex
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EVALUARE - anamneza VG, GN, TN, alimentatie, boli in prima copilarie, G si T familiei, situatie psihoeconomica…- examen clinic aspect armonic/disarmonic, dismorfism facial, G,T, perimetre, strat adipos, dezvoltare pubertara, dezvoltare psihosociala
! Viteza de crestere
VARSTA OSOASA indicator pentru varsta fiziologica a copilului; se compara cu varsta cronologica si cu varsta taliei
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RETARD STATURAL SECUNDARCauze viscerale/metabolice –boli cronice, grave, cu debut precoceCauze nutritionaleCauze afective
RETARD STATURAL de cauza OSOASAAnomalii la nivelul meta/epifizelor, coloanei lombare Dismorfism craniofacial, retard mental, anomalii organice RETARD STATURAL DE CAUZA ENDOCRINA
-insuficienta tiroidiana, insuficienta hipofizara, hipercorticism RETARD STATURAL ESENTIAL
- retard statural ereditar / talie mica familiala(T intre -2DS si -3DS)
- retard de crestere intrauterin –de la nastere, etiologie variabila, partial recuperabil in primele luni
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DEFINITIE : TALIE > +2DS (>p 97)
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CAUZE1. Talie mare constitutionala
2. Circumstante patologice Cauze endocrine – hipersecretie hh de crestere
- secretie crescuta hh sexuali - (pseudo)pubertate precoce
- hipertiroidism - hiperinsulinism
Cauze nonendocrine asociate sdr.malformative /dismorfice (gigantism cerebral, sdr.Marfan,
Beckwith Wiedemann,)
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Necesita urmarirea perimetrului cranian, a evolutiei fontanelelor si a suturilor
Suturile inchise la nastere normal FP inchisa la nastere FA inchisa intre 6-18 luni
MICROCEFALIE PC ≤ -3DS (p1) MACROCEFALIE PC ≥ + 2DS (p97)
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CRANIOSTENOZA (coronara, globala) MICROCEFALIE AUTOSOMALA RECESIVA -
microcefalie, dismorfism craniofacial, frunte tesita, occiput plat, retard mental
HOLOPROSENCEFALIA – microcefalie, anomalii cerebrale, hipotelorism, fante palpebrale oblice, oase piramida nazala nedezvoltate, agenezie maxilar, retard mental si deficite motorii severe
SDR.CORNELIA DE LANGE - microcefalie, talie mica, facies caracteristic (sprincene groase unite, fante palpebrale alungite, nas mic, buze subtiri, microretrognatie), anomalii cardiace/renale, retard mental
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DEFINITIE PC ≥ + 2DS (p97)
MACROCEFALIE FAMILIALA PC >2DS, viteza crestere normala
MACROCEFALIE PATOLOGICA PC >3DS, viteza de crestere excesiva
- HIDROCEFALIE - HEMATOM SUBDURAL
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Acumulare de LCR sub presiune in cavitatile ventriculare
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CLINIC Crestere rapida PC ; FA larga, suturi dehiscente,
subtierea oaselor craniene si a scalpului, turgescenta venelor superficiale, privire in apus de soare
Cefalee Varsaturi Tulburari vizuale / de ideatie / de activitate / de
vorbire / Tremuraturi, incoordinare Agitatie, tipat cerebral, decerebrare - LCR se
acumuleaza rapid
DIAGNOSTIC imagistic (ETF, CT, RMN), FO
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